{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T08:50:54Z","timestamp":1758444654213,"version":"3.44.0"},"reference-count":4,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2016,9,8]]},"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec>\n                  <jats:title>Clinical introduction<\/jats:title>\n                  <jats:p>A 50-year-old hypertensive smoker presented with a typical angina of 2\u2005days duration. An urgent ECG revealed extensive anterior wall myocardial infarction. In view of the delayed presentation, the patient was conservatively managed with heparin. In-hospital echocardiogram showed akinesia of entire left anterior descending artery (LAD) territory with severe left ventricular (LV) dysfunction. He was discharged with a plan for early coronary intervention. However, he presented a fortnight later with acute pulmonary oedema. General appraisal revealed a restless individual who was dyspnoeic and diaphoretic at rest. On clinical examination, the patient was in hypotension with features of biventricular failure. A 12-lead ECG showed QS pattern with persistent ST segment elevation in precordial leads. The chest radiograph demonstrated features of pulmonary oedema, cardiomegaly and bilateral pleural effusion. Creatine Phosphokinase-MB (CPK-MB) was negative. A preliminary transthoracic echocardiography was done (figure 1 and see online supplementary video 1).<\/jats:p>\n                  <jats:fig id=\"HEARTJNL2016309715F1\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Figure\u00a01<\/jats:label>\n                     <jats:caption>\n                        <jats:p>(A) Trans thoracic echocardiogram-apical 4 chamber view; (B) zoomed view of apex; (C) colour Doppler at left ventricular (LV) apex and (D) bulls-eye plot of strain imaging.<\/jats:p>\n                     <\/jats:caption>\n                     <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"heartjnl2016309715f01.tif\" position=\"float\" orientation=\"portrait\"\/>\n                  <\/jats:fig>\n                  <jats:supplementary-material id=\"SM1\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>supplementary video<\/jats:label>\n                     <jats:p>\n                        <jats:inline-supplementary-material xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"ss1\" mimetype=\"video\" mime-subtype=\"mp4\" xlink:href=\"heartjnl-2016-309715supp_video1.mp4\"\/>\n                     <\/jats:p>\n                  <\/jats:supplementary-material>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Question<\/jats:title>\n                  <jats:p>What is the most likely diagnosis based on the echocardiogram?\n<jats:list list-type=\"alpha-upper\">\n                        <jats:list-item>\n                           <jats:p>LV pseudo-aneurysm with contained rupture<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Dissecting intramural haematoma of LV apex<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Ventricular apical aneurysm with thrombus<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>LV non-compaction with prominent ventricular trabaculations<\/jats:p>\n                        <\/jats:list-item>\n                     <\/jats:list>\n                  <\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2016-309715","type":"journal-article","created":{"date-parts":[[2016,9,29]],"date-time":"2016-09-29T22:39:05Z","timestamp":1475188745000},"page":"508.1-516","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["A case of recent myocardial infarction with cardiac failure"],"prefix":"10.1136","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5589-9741","authenticated-orcid":false,"given":"Anishkumar","family":"Nair","sequence":"first","affiliation":[{"name":"Department of Cardiology, Government Medical College, Kozhikode, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chakanalil Govindan","family":"Sajeev","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Government Medical College, Kozhikode, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kader","family":"Muneer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Government Medical College, Kozhikode, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,9,29]]},"reference":[{"key":"2025092001155464000_103.7.508.1","first-page":"107","article-title":"Left ventricular pseudoaneurysm","volume":"9","author":"Tuan","year":"2008","journal-title":"Eur J Echocardiogr"},{"key":"2025092001155464000_103.7.508.2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-301962"},{"key":"2025092001155464000_103.7.508.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8175.2008.00804.x"},{"key":"2025092001155464000_103.7.508.4","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000132478.60674.D0"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2016-309715","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T08:16:04Z","timestamp":1758356164000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2016-309715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9,29]]},"references-count":4,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2017,3,13]]},"published-print":{"date-parts":[[2017,4]]}},"alternative-id":["10.1136\/heartjnl-2016-309715"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2016-309715","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"type":"print","value":"1355-6037"},{"type":"electronic","value":"1468-201X"}],"subject":[],"published":{"date-parts":[[2016,9,29]]}}}